Learn expert tips for the diagnosis and management of inflammatory bowel disease (IBD) from Dr. Adam Ehrlich, Assistant Professor of Medicine and co-director of the Inflammatory Bowel Disease Program at Temple University Hospital. In this episode, we learn about the initial work-up, general principles of management, and important primary care considerations for Crohn’s disease and ulcerative colitis (ie endoscopic surveillance, immunizations, bone health/osteoporosis, and more!).
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- Written and produced by: Paul Williams MD
- Edited by: Matthew Watto MD
- Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
- Guest: Adam Ehrlich MD
Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.
- 00:00 Sponsor: MKSAP 18
- 00:32 Disclaimer, Intro, guest bio
- 04:05 Guest one-liner, Adam’s movie rec - RBG (documentary), career advice, Paul’s movie rec - Edge of Tomorrow
- 09:25 Sponsor: ACP’s MKSAP 18
- 11:25 Definitions and pathophysiology of inflammatory bowel disease (IBD)
- 13:40 A case of ulcerative colitis; Classic symptoms; Initial approach and basic differential diagnosis
- 19:10 Smoking and ulcerative colitis
- 21:17 Initial workup for suspected IBD; Fecal calprotectin
- 25:50 A bit more on CRP and IBD
- 26:55 When to refer for colonoscopy
- 27:58 Back to the case; a typical colonoscopy reports in ulcerative colitis (UC)
- 30:33 Extraintestinal manifestations of UC
- 34:50 Initial counseling for newly diagnosed IBD; natural history of IBD, prognosis
- 39:50 Treatment of ulcerative colitis
- 43:02 Some specifics on steroids, plus topical therapies
- 47:05 A case of Crohn’s disease; initial approach and differential diagnosis
- 50:25 Initial diagnostic testing; colonoscopy findings in Crohn’s; IBD trivia
- 53:58 Treatment of Crohn’s disease
- 58:26 Specifics about biologic therapy for IBD; Endpoints
- 62:25 Steroid sparing agents, immunomodulators like azathioprine, 6-mercaptopurine
- 64:48 Can drug therapy be stopped or tapered in IBD?
- 66:50 Prognosis in Crohn’s and initial patient counseling
Primary Care considerations
- 68:35 Surveillance endoscopy,
- 71:47 Do diet and lifestyle changes for IBD work? What about pregnancy?
- 76:31 Immunizations
- 79:25 Bone health, osteoporosis and IBD, screening for iron and nutritional deficiencies
- 82:27 Take home points
- 86:28 Outro